Individual
DR. GARY T COBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
725 N LINCOLN ROAD, ROCKVILLE, IN 47872
(765) 569-2008
(765) 569-2009
Mailing address
PO BOX 278, ROCKVILLE, IN 47872-0278
(765) 569-2008
(765) 569-2009
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001654
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000264522
ANTHEM PIN
IN
01
—
000000264646
ANTHEM
IN
05
—
200954600
—
IN
01
—
410046751
RAILROAD MEDICARE
IN
Enumeration date
01/04/2007
Last updated
03/20/2012
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